Provider Demographics
NPI:1851547319
Name:GUTIERREZ, RICARDO JESUS (PTA)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:JESUS
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 NORTHGATE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3672
Mailing Address - Country:US
Mailing Address - Phone:956-605-7425
Mailing Address - Fax:
Practice Address - Street 1:5413 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2206
Practice Address - Country:US
Practice Address - Phone:956-618-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2034288225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant